CBT for Anxiety in Children and Adolescents

in Anxiety / Stress Management  by Adolescent Counseling Services 0 comments

Written By: Bradley Chamberlin, Clinical Trainee at ACS, On-Campus Counseling Program

COGNITIVE BEHAVIORAL THERAPY(CBT) is an evidence-based treatment for mental illness that has risen in popularity since it was first developed in the 1960s (Chand et al., 2023). Since then, CBT has been used to treat a variety of mental disorders, including anxiety disorders. Furthermore, it has since been adapted for use in treating children and adolescents. CBT is currently categorized as “level 1 – best support” by the Blue Menu of Evidence-Based Psychosocial Interventions for Youth for its use in treating children and adolescents with anxious or avoidant behaviors (“Blue Menu,” 2025). As such, CBT is a promising treatment option for clinicians treating children and adolescents with anxiety disorders.

An overview of the basic components of CBT for anxiety in children and adolescents includes a few elements, such as incorporating cognition into therapy and the tripartite model (Gosch et al., 2006). As the name suggests, CBT emphasizes incorporating cognitions into treatment to aid the client in better understanding themself, thereby opening the door for improvements in such areas. For example, CBT may explore a child’s sense of self-efficacy as well as their belief that they are or are not able to cope with stressors. Similarly, an important component of CBT is social learning theory and exploring how past experiences have shaped children’s anxiety responses (Bandura, 1971). According to social learning theory, individuals learn anxiety responses through the observation of others, and discussing the origins of children’s anxiety responses may aid them in breaking this cycle and learning more constructive coping strategies.

The tripartite model utilized in CBT views anxiety disorders as arising from the three components of the model: genetic vulnerability, general psychological vulnerability pertaining to uncontrollable threats, and specific psychological vulnerability pertaining to early learning experiences (Gosch et al., 2006). These three factors influence the level of control that one feels over their stressors, thereby affecting one’s anxiety response. Utilizing the tripartite model in therapy may involve addressing specific vulnerabilities that are affecting the child’s presentation of anxiety symptoms, thereby better equipping them to cope with stressors in the future.

CBT incorporates core techniques into the treatment of mental illness. One important technique utilized in CBT for the treatment of anxiety in children is psychoeducation (Gosch et al., 2006). Educating clients on the nature of anxiety can open the door for exploring the origins of their anxiety and thereby facilitate the treatment of it. Furthermore, this process can help to shape the client’s expectations for treatment and outcomes. Another core technique utilized by this treatment modality is the development of coping skills, which may come in a variety of forms. Therapists may aid their clients in developing coping skills through somatic education, thereby empowering them to recognize their feelings; through somatic management, thereby empowering them to manage their emotions through skills such as muscle relaxation; or problem-solving, thereby empowering them to engage in problem-solving strategies. Finally, another technique used in this therapeutic modality is exposure to help disconnect learned associations between stressors and incompatible anxiety responses.

Ideal candidates for CBT for children with anxiety would be children or adolescents experiencing anxiety symptoms who do not have parents with an anxiety disorder (Gosch et al., 2006). Some evidence suggests that children presenting with anxiety symptoms who have a parent with an anxiety disorder may benefit more from family treatment. Furthermore, the ideal candidate for this form of treatment will have mild to moderate anxiety or severe anxiety if the client is also taking psychiatric medication (Bubrick, 2023). The duration of treatment depends on the severity of the anxiety symptoms that the client presents with; however, for moderate cases, treatment typically lasts eight to 12 sessions.

One benefit of utilizing CBT in the treatment of anxiety in children and adolescents is the variety of treatment settings in which it can be applied. CBT has been found to be effective in treating anxiety in children through individual therapy, group therapy, family therapy, in-person therapy, and remote therapy (Sigurvinsdóttir et al., 2020). Furthermore, the brevity of the treatment is a benefit due to the increase in accessibility for cost and time commitment.

One limitation of CBT for anxiety in children and adolescents is if children have a family member with an anxiety disorder (Gosch et al., 2006). Children may learn anxiety responses from others whom they are close to, and if the child has frequent contact with others who model incompatible anxiety responses, the child may learn these responses, thereby affecting the effectiveness of CBT. Furthermore, this treatment modality has limitations in treating individuals with comorbid autism spectrum disorder (ASD) (Van Steensel & Bögels, 2015). Although CBT has been found to be effective in treating anxiety disorders in children with comorbid ASD, it was found to be less effective compared to treating children without the comorbid diagnosis.

In review, CBT is an evidence-based treatment modality that can be incorporated into child and adolescent therapy. This theoretical orientation of therapy is especially effective for children and adolescents diagnosed with anxiety disorders; however, it is important to take all aspects of the clients’ identities into consideration when determining if CBT is a good fit.

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References

Bandura, A. (1971). Social Learning Theory. General Learning Press. Blue menu of evidence-based interventions. (n.d.). Retrieved March 6, 2025, from https://www.practicewise.com/Community/BlueMenu

Bubrick, J. (2023, October 30). Behavioral treatment for kids with anxiety. Child Mind Institute. https://childmind.org/article/behavioral-treatment-kids-anxiety/

Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2025). Cognitive behavior therapy. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK470241/

Gosch, E. A., Flannery-Schroeder, E., Mauro, C. F., & Compton, S. N. (2006). Principles of cognitive-behavioral therapy for anxiety disorders in children. Journal of Cognitive Psychotherapy, 20(3), 247–262. https://doi.org/10.1891/jcop.20.3.247

Ishikawa, S., Kikuta, K., Sakai, M., Mitamura, T., Motomura, N., & Hudson, J. L. (2019). A randomized controlled trial of a bidirectional cultural adaptation of cognitive behavior therapy for children and adolescents with anxiety disorders. Behaviour Research and Therapy, 120, 103432. https://doi.org/10.1016/j.brat.2019.103432

Sigurvinsdóttir, A. L., Jensínudóttir, K. B., Baldvinsdóttir, K. D., Smárason, O., & Skarphedinsson, G. (2020). Effectiveness of cognitive behavioral therapy (Cbt) for child and adolescent anxiety disorders across different CBT modalities and comparisons: A systematic review and meta-analysis. Nordic Journal of Psychiatry, 74(3), 168–180. https://doi.org/10.1080/08039488.2019.1686653

Van Steensel, F. J. A., & Bögels, S. M. (2015). Cbt for anxiety disorders in children with and without autism spectrum disorders. Journal of Consulting and Clinical Psychology, 83(3), 512–523. https://doi.org/10.1037/a0039108